EFFECTS OF EPIDURAL CORTICOSTEROID ACCOMPANIED BY FLUOROSCOPY ON PAIN VALUES OF PATIENTS WITH SYMPTOMATIC CERVICAL DISCOPATHY

Amaç: Semptom veren servikal diskopatisi olan hastalarda, Servikal İnterlaminar Epidural Steroid Enjeksiyonu (SİESE)’unun Visual Analogua Scale (VAS) değerleri üzerine etkilerini incelemeyi amaçladık. Yöntemler: 01 Şubat 2011 – 01 Temmuz 2012 tarihleri arasında, 45 hastada semptomatik servikal diskopatiye bağlı radikülopati tedavisinde uyguladığımız SİESE'nin, VAS değerleri üzerine olan etkilerini geriye dönük olarak inceledik. Hastalar yan yatar pozisyonda iken C7-T1 aralığından floroskopi eşliğinde Low-rezistans tekniği ile epidural aralığa 80 mg triamsinolon ve 3 mL serum fizyolojik karışımı toplam 5 mL volüm içinde enjekte edildi. Bulgular: Servikal interlaminar epidural steroid enjeksiyonu uygulaması sonrası hastaların VAS skorları bazal VAS skorlarına göre istatistiksel olarak anlamlı düşüktü. SİESE sonrası başarı oranları sırasıyla 1. hafta %85, 1. ay %95, 6. ay %89 ve 1. yıl %89'du. Sonuç: Servikal interlaminar epidural steroid enjeksiyonu uygulaması semptomatik diskopati tedavisinde etkili bir yöntemdir ve hasta memnuniyetini arttırır

Approach to The Occluded Permanent Hemodialysis Catheter

Objective: Central venous catheterization (CVC) is a type of surgery that hemodialysis (HD) patients frequently undergo. Presently, permanent CVCs (pCVCs) are the alternative to vascular access for patients requiring long-term catheterization. Additionally, identification of the type of catheter has a great importance for the right intervention.Our study aims: The aim was to discuss the identification procedure of an HD catheter, whether it is permanent or temporary, by presenting an HD catheter case done by CVC.Case presentation: A 75-year-old female patient having a routine of 3 days/week HD treatment was admitted to the critical care unit. A nonfunctional HD catheter was present in the left subclavian vein. A new HD catheter was placed in the right subclavian vein and continuous renal replacement therapy with heparin was initiated. Radiography revealed an opacity with a size of around 3 cm detected at the tip of the nonfunctional catheter. The catheter was removed with an incision after an unsuccessful attempt of removal by pulling it out. Further investigation of the catheter revealed that it was occluded.Conclusion:It is crucial to determine whether the catheter is temporary or permanent in order to do the right intervention and not to have unwanted consequences while removing a nonfunctional HD catheter

Clinical Study Gastric Decompression Decreases Postoperative Nausea and Vomiting in ENT Surgery

There is a passive blood flow to the stomach during oral and nasal surgery. It may cause postoperative nausea and vomiting (PONV). We researched the relationship between gastric decompression (GD) and severity of PONV in ear, nose, and throat (ENT) surgery. 137 patients who have been into ENT surgery were included in the study. In Group I ( = 70), patients received GD after surgery before extubation; patients in Group II ( = 67) did not receive GD. In postoperative 2nd, 4th, 8th, and 12th hours, the number and ratio of patients demonstrating PONV were detected to be significantly more in Group II as compared to Group I. PONV was also significantly more severe in Group II as compared to Group I. In Group I, the PONV ratio in the 2nd hour was significantly more for those whose amounts of stomach content aspired were more than 10 mL as compared to those whose stomach content aspired was less than 10 mL. In the 4th, 8th, and 24th hours, there is no statistically significant difference between the stomach content aspired and PONV ratio. GD reduces the incidence and severity of PONV in ENT surgery

Anesthesia Management in a Patient with Cystic Fibrosis (A Case Report)

Cystic fibrosis (CF) is a hereditary disease resulting from a chlorine channel defect with autosomal recessive transmission, a structural and functional disorder in the transport of chlorine (Cl) through the plasma membrane in epithelial cells in organs such as the lungs, pancreas, liver, intestines, sweat glands, and epididymis. The most affected regions are the lungs and the gastrointestinal system. These cases are important for their perioperative respiratory complications. We present an anesthesia method conducted on a 16-year-old female CF case receiving general anesthesia

ANESTHETIC MANAGEMENT IN A PATIENT WITH KEARNS-SAYRE SYNDROME

Kearns-Sayre sendromu; Kronik-progresif, eksternal oftalmopleji ve pigmenter retinadejenerasyonu ile karakterize, 20 yaşından önce bulgu veren, mitokondriyal birhastalıktır. Kearns-Sayre sendromlu hastalarda; potansiyel aspirasyon riski, zayıffaringeal kas kontrolü ve oral sekresyonlara bağlı hava yolu komplikasyonlarınedeniyle, genel anestezi uygulaması dikkatli bir şekilde yürütülmelidir. Kalp iletimdefektleri de hastalığın sık görülen ve önlenebilen ölümcül komplikasyonlarındandır.Bu sunuda; Kearns-Sayre sendromlu bir hastaya olan anestezik yaklaşımımızı sunmayıamaçladık. Kearns-Sayre syndrome is a mitochondrial dissease characterized by a triad of featuresincluding oncet in persons younger than 20 years, chronic progressive externalophtalmoplegia and pigmentary degeneration of retina. In patient with Kearns-Sayresyndrome, General anesthetic management should be carefully implemented inconsideration of the potantial risk of aspiration and air-way complications due to poorpharyngeal muscle control and oral secretions. Cardiac conduction defects aresignificant and preventable cause of mortality. Here we aimed to report our anestheticmanagement of a patient with Kearns- Sayre syndrome

Isoflurane exposure in infant rats acutely increases aquaporin 4 and does not cause neurocognitive impairment

Isoflurane is commonly used in pediatric population, but its mechanism of action in cognition is unclear. Aquaporin 4 (AQP4) regulates water content in blood, brain, and cerebrospinal fluid. Various studies have provided evidence for the role of AQP4 in synaptic plasticity and neurocognition. In this study, we aimed to determine whether a prolonged exposure to isoflurane in infant rats is associated with cognition and what effect this exposure has on AQP4 expression. Ten-day-old [postnatal day (P) 10] Wistar albino rats were randomly allocated to isoflurane group (n = 32; 1.5% isoflurane in 50% oxygen for 6 hours) or control group (n = 32; only 50% oxygen for 6 hours). Acute (P11) and long-term (P33) effects of 6-hour anesthetic isoflurane exposure on AQP4 expression were analyzed in whole brains of P11 and P33 rats by RT-qPCR and Western blot. Spatial learning and memory were assessed on P28 to P33 days by Morris Water Maze (MWM) test. The analysis revealed that isoflurane increased acutely both mRNA (~4.5 fold) and protein (~90%) levels of AQP4 in P11 rats compared with control group. The increasing levels of AQP4 in P11 were not observed in P33 rats. Also, no statistically significant change between isoflurane and control groups was observed in the latency to find the platform during MWM training and probe trial. Our results indicate that a single exposure to isoflurane anesthesia does not influence cognition in infant rats. In this case, acutely increased AQP4 after isoflurane anesthesia may have a protective role in neurocognition

Management with Guidance of Minimally Invasive Cardiac Output Monitoring (PiCCO®) in Coronary Artery Bypass Surgery and Postoperative Results

Objective:Our study aimed to assess the correlation between the measured PiCCO® parameters and extubation time and intensive care unit (ICU) length of stay in patients who underwent coronary artery bypass grafting (CABG) surgery and were managed by monitorization of cardiac output and cardiac performance parameters with PiCCO®.Method:This study was conducted by retrospective analysis data of all 44 patients who underwent CABG surgery during December 2015-March 2016 and were managed through PiCCO® monitorization. The patients’ demographic characteristics (age, sex, weight, height, body mass index), American Society of Anesthesiologists physical conditions, comorbidities, ejection fractions, anesthetic management, operative details, hemodynamic data, PiCCO® parameters, extubation times, cardiovascular surgery ICU lengths of stay, requirements for vasoactive agent and blood transfusion, mortality, and morbidity were recorded from patient records and evaluated the correlation between the measured PiCCO® parameters and extubation time and ICU length of stay inpatients.Results:A significant increase was detected in the parameters of cardiac contractility and performance monitored with PiCCO® in the postoperative period (p<0.05). No significant correlation was found between PiCCO® parameters and extubation time and ICU length of stay (p<0.05).Conclusion:Coronary revascularization patients managed with the guidance of PiCCO® showed improved myocardial contractility and cardiac performance and no increase beyond what is anticipated in the extubation time and ICU lengths of stay of the patients. Thus, we believe that optimum volume and hemodynamic targets can be achieved in patients managed through monitorization of cardiac function parameters

Anesthesia Management in Robinow Syndrome (A Case Report)

Robinow Syndrome (RS) is a rare disease characterized by anomalies in the face, head, external reproductive organs, and spine segmentation. The three main symptoms of the syndrome are fetal face appearance, genital hypoplasia, and gingival hyperplasia. Fifteen percent of the cases have congenital heart defects. Short neck, large tongue, and airway problems due to a structural disorder of the face may be observed. In this paper, we present our anesthesia practice in a case that had been diagnosed with RS

Evaluation of Readmitted Patients After Intensive Care Unit Discharge (Retrospective Study)

Objective:Nearly %10 of the discharged patients are readmitted to intensive care unit (ICU) at the same hospital stay. Reduction of readmission rates could be used as a hospital performance indicator. Our aim is to analyse the reasons and results of readmissions of patients who were discharged to a general ward from ICU in a two-year period.Method:Readmissions of the patients who had been treated in our ICU between the dates of 01.01.2015-31.12.2016 were analysed retrospectively. Demographic characteristics of patients, readmission rates, initial admission indications and comorbidities, distribution of readmission indications, timing of readmission after discharge, distribution of patients in terms of mechanical ventilation need, discharge time of readmitted patients at initial admission to ICU after weaning, readmission mortality rates, Glasgow Coma Scale (GCS), APACHE-II and SOFA scores of patients at initial admission and readmission were analysed and compared.Results:59 patients (3.55%) are readmitted to ICU after discharge at the same hospital stay. When examining the departments where the readmitted patients came from, it is seen that 19 patients (32.2%) were readmitted to ICU from department of general surgery. 22 of readmissions (37.29%) occurred within first 48 hours after discharge. The most common reasons of readmissions are for postoperative monitoring after revisional surgery (44.07%) and acute respiratory failure (40.68%).Conclusion:The patients who are discharged from ICU are at a high risk of being readmitted to ICU (35). Readmission to ICU is associated with higher mortality risk than the initial admission. The first step of reducing the rates of readmission to ICU process is to anticipate the patients who would be readmitted to ICU priorly and improve service wards healthcare quality

Comparison of the Effect of Different Anesthesia Maintenance on Hemodynamics in Coronary Artery Bypass Grafting Surgery: A Retrospective Cohort Study

Objective:General anesthesia management in coronary artery bypass graft surgery (CABGC) should preserve myocardial function, prevent ischemic damage, and maintain stable hemodynamics. There is not a universally accepted technique for anesthetic management during CABGC. Drugs or drug combinations and maintenance of infusions are decided based on the pathophysiological condition of the patient and the individual preference and experience of the anesthesiologist (1). Although there are many studies about an anesthesia induction in CABGC, studies about anesthetic maintenance are very limited. In this study, we compared the hemodynamic effects of three different methods that were used in anesthetic maintenance in CABGC.Method:The retrospective records of 108 patients in ASA II-III group who underwent elective CABGC were divided into 3 groups according to their anesthetic maintenance methods. Group I was maintained with 1-3% sevoflurane and fentanyl 4 mcg/kg/hour infusion, group II with propofol 1.5-4 mg/kg/hour and fentanyl 4 mcg/kg/hour infusion, and group III with propofol 1.5-4 mg/kg/hour and remifentanil infusion of 0.03 mg/kg/hour. Systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP) and heart rate (HR) were measured and recorded after induction (T0), after sternotomy (T1), after pericardiotomy (T2), 5 minutes after cardiopulmonary bypass (CPB) (T3), after thorax closure (T4), at the end of the operation (T5). The vasodilator requirements in the time period before CBP and the inotropic agent requirements after CPB were noted.Results:Data of 108 patients (88 men/20 women) were analyzed. Demographic characteristics of the patients were similar in all the groups. Statistical analysis was made among the groups depending on coronary artery bypass graft number, cross-clamp time, total fluid administration, total blood transfusion, total urine volume, inotropic agent requirement after CPB, postoperative central venous pressure, and pre- and postoperative lactate levels; however, there was no statistical difference. There was not change more than 20-25% in MAP and HR in group I than the others.Conclusion:Better hemodynamic results were achived with sevoflurane and fentanyl in the anesthetic maintenance of CABGC